Treating Cancer. Personalised medicine Read about the breakthrough research transforming cancer treatment P3

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1 A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE INDEPENDENT SEPTEMBER HEALTHAWARENESS.CO.UK READ Hope for advancing melanoma treatment P4 WATCH Video: origins of the myeloma cell from Myeloma UK READ Why we need to change our attitude towards pancreatic cancer P6 Treating Cancer Personalised medicine Read about the breakthrough research transforming cancer treatment P3 PHOTO CREDIT: ZHUDIFENG

2 2 HEALTHAWARENESS.CO.UK A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE INDEPENDENT IN THIS ISSUE Infographic Find all the myeloma stats you need to know, including the key symptoms to look out for P5 Standards of care GP access to diagnosis is key for treating pancreatic cancer, says Ali Stunt, CEO, Pancreatic Cancer Action P6 READ MORE ON HEALTHAWARENESS.CO.UK Watch now See our video on the startling effect of Myeloma on bone marrow, from Myeloma UK Working together to make progress against cancer Collaboration in research is key to building on the huge progress we ve already made in treating cancer, and to help bring new treatments to patients faster. Since I became director at the National Cancer Research Institute (NCRI), it has become clear what a strong commitment there is to partnership working in cancer research in the UK; particularly across research funders, institutions and clinical networks, and with the active involvement of patients and carers. This ethos of working together, coupled with world-leading research, has dramatically accelerated progress. Survival is higher than ever and half of all cancer patients now survive for at least 10 years after diagnosis. Thanks to research and collaboration, our understanding of cancer has grown hugely. This has led to important advances in treatment and the way we manage the disease. A revolution in genetic sequencing means personalised cancer medicine is now a real prospect, and treatments can be given to those most likely to benefit. We re also developing smarter technologies and techniques in well-established treatments like radiotherapy, making it more precise, more effective and with fewer side effects. Immunotherapy One area that is causing huge excitement is immunotherapy harnessing the power of the immune system to recognise and destroy cancer cells. These treatments have shown some dramatic results in early stage clinical trials and we are all watching to see how they translate into treatments in the clinic. Karen Kennedy Director, National Cancer Research Institute Personalised cancer medicine is now a real prospect, and treatments can be given to those most likely to benefi t At least a third of all cancer cases are preventable, so finding ways to encourage healthy behaviour will help prevent many cancers and other chronic diseases. We also know that the earlier cancer is diagnosed, the more effective treatment will be, which is why screening and public awareness are key areas. With around 2.5 million people now living with cancer in the UK, research is essential to help these people live well and find solutions to problems such as the long-term effects of treatment. We must also find better ways to provide care and support for people at the end of their lives. As a UK-wide partnership between cancer research funders, the NCRI coordinates and oversees the research that underpins this progress. This is important in such a diverse field: there are more than 200 types of cancer and, across the UK, a breadth of funders, industry partners and medical, scientific and other experts involved in research, as well as patients themselves. The annual NCRI Conference in Liverpool each November is one way we bring everyone together to share research and knowledge, and strengthen partnerships. We ve seen so much progress there could be a temptation to say that it s time to move on to other diseases. But half of people will now be diagnosed with cancer at some point in their lifetime. Working together to keep the momentum going is vital to ensure we can bring the benefits of research to patients and the public faster. Follow Please Recycle Managing Director: Carl Soderblom Content and Production Manager: Henrietta Hunter Designer: Danielle Stagg Business Developer: Rebecca Nicholson Project Manager: Lucy Arden lucy.arden@mediaplanet.com Mediaplanet contact information: Phone: +44 (0) info.uk@mediaplanet.com

3 A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE INDEPENDENT MEDIAPLANET 3 Professor David Cunningham Director, National Institute for Health Research (NIHR) Surgery and radiotherapy, while good treatments, can only treat the disease where it is visible. Chemotherapy does treat the whole body, but it can cause side effects, and some cancers can become resistant to it. Breakthrough advances in cancer treatment and research Innovative approaches to the management of cancer, from immunotherapy to liquid biopsies, are improving patient outcomes. We need to ensure that progress continues. There have been many important advances in cancer research recently, but it s probably immunotherapy and the use of new antibodies known as immune checkpoint inhibitors that are causing the most excitement today, says Professor David Cunningham, Consultant Medical Oncologist at the Royal Marsden and Director of the NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research, London. There are special cells in our immune system, called T cells, which protect us from harmful agents. But tumour cells can attach to T cells, deactivating them. Immune checkpoint inhibitors can prevent this by locking onto either T cells or tumour cells, effectively freeing the immune system to attack the cancer. Impact on melanoma Immunotherapy is making a difference, particularly in malignant melanoma, the most serious form of skin cancer, says Cunningham. We can now eradicate the disease, or provide longterm remissions a reduction or absence of symptoms in a proportion of patients, he adds. A recent study in the New England Journal of Medicine found that people with advanced melanoma who received a combination of two Breakthrough advances of recent years have enormous positive implications for the future of cancer treatment PHOTO CREDIT: LUCHSCHEN immuno-therapy drugs lived about a year without the disease progressing. The finding could have crucial implications for the over 13,000 people who are diagnosed with the condition in the UK each year. Cunningham notes: Some patients treated with immunotherapy are still alive up to ten years later. It s quite possible that melanoma will be cured in the future. The research is now expanding to malignancies like kidney, lung and gastrointestinal cancers. And the results are also looking promising. The big advantage of immunotherapy is that it treats the whole body, for our immune cells can attack cancer cells wherever these may be. Liquid biopsies Another rapidly advancing area is liquid biopsies to diagnose cancer noninvasively by detecting tumour cells in a person s blood, rather than from tissue samples. The technology allows us also to monitor cancer in individual patients, in order to identify gene mutations that may cause their treatment to fail or accelerate the disease. Liquid biopsies can identify these harmful mutations by analysing fragments of tumour DNA that detach from the primary cancer and circulate in the patient s blood. They could be useful in prostate cancer, for instance, in which drugs used to control the disease appear to speed up tumour growth in some patients. Continuing progress The breakthrough advances of recent years have enormous positive implications for the future of cancer treatment. But we need to ensure that progress continues. Cunningham says: There are three key factors to this: a better understanding of the basic science of cancer processes, translating this new knowledge into clinical practice, and feeding the information we get from clinical practice and trials back into basic science, so that we can constantly improve our approach to the treatment of cancer.

4 4 HEALTHAWARENESS.CO.UK A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE INDEPENDENT INSPIRATION EXPERT INSIGHT Read the full story at healthawareness.co.uk Dr Rakesh Popat Consultant haematologist, University College London Hospitals Multiple myeloma Each year in the UK nearly 4,800 people are diagnosed with multiple myeloma, an incurable cancer of the bone marrow which mostly develops after the age of 60. Despite treatment advances, the condition has huge effects on quality of life. The best way to visualise multiple myeloma is as many small lumps of cancer cells across the bone marrow, says Dr Rakesh Popat, a consultant haematologist at University College London Hospitals. Symptoms include back pain, fatigue and, less commonly, kidney damage. They vary among patients, which is why there is often a delay in detecting the condition. Yet early diagnosis is key to starting treatment before complications occur and in turn increasing the chance of a better quality of life. This is important, because multiple myeloma has a huge impact on patients. Chronic pain limits their ability to move, work and socialise. The fact that remissions, which may require no treatment, alternate with relapses, which require treatment, also makes things difficult. We see people from all walks of life, with jobs and families. They have to find a way to live with the disease, knowing that, even though they may be in remission, the cancer will come back, says Dr Popat. He is, however, optimistic about the future. Thanks to early diagnoses and more effective, well-tolerated therapies, we might be able to cure some patients and keep those we can t cure alive longer, while maintaining a very good quality of life. Ultimately, we might be able to turn multiple myeloma into a chronic disease, just like diabetes or high blood pressure. Cooperation is key Advancing myeloma treatment means working collaboratively and strategically and engaging early with downstream stakeholders By Eric Low Myeloma is a rare, relapsing and remitting cancer of the plasma cells found in bone marrow. Every year 4,800 people in the UK are diagnosed with myeloma. There is currently no cure; and treatment options are focused on managing and extending the lives of patients. Advances in the treatment over the last decade or so have resulted in survival for patients improving at a faster rate than almost any other cancer in the UK. However, overall survival remains poor and almost every myeloma patient will die of the cancer and/or its complications. There has been innovation in research into the genetics and biology of myeloma, and there are a number of novel new treatments coming down the line. However, without collaboration and streamlining in drug discovery and development, and earlier engagement with regulators, health technology assessment (HTA) bodies and payers, patients may not fully benefit from this innovation. Delivering effective treatment and improved care Treatment of myeloma consists of combinations of anti-myeloma drugs and high-dose therapy, and stem cell transplantation in eligible patients. Treatment is largely dictated by national guidance rather than by the informed choice of

5 A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE INDEPENDENT MEDIAPLANET 5 PHOTOCREDIT: MYELOMA UK doctors and patients. This means that all patients get the same treatment irrespective of individual disease, clinical or personal factors. In addition to being relapsing and remitting, myeloma is not one cancer but is made up of several different types ranging from high risk with a poor prognosis to low risk with a more favourable prognosis. What is more, we know evidence suggests that the majority of treatments do not work in every patient. This has a negative impact on survival and quality of life as well as the emotional state of patients and their families. If we are to overcome these problems, and truly realise the benefit of innovation in the pipeline, we need to think differently about how research is done in order to generate the evidence needed to ensure that patients get the right treatment at the right time. Significant investment is needed in stratified medicine and in the design of clinical development programmes. To ensure the process is robust, it must be informed by genetic subtypes and real-world needs of patients, Eric Low Chief executive, Myeloma UK We need to think differently about how research is done healthcare professionals and payers. There is also a requirement for more sophisticated platforms for translating evidence into clinical practice and treatment algorithms that better reflect the heterogeneity of myeloma. If this can be achieved, it will make the identification and prioritisation of pipeline treatments easier and speed up the development journey. Accessing treatment There are a number of promising new treatments coming down the line however there are likely to be challenges in securing access to these drugs for patients. For far too long clinical trial programmes have developed trials based solely on safety and efficacy to get a licence this is not compatible with the data and information of the UK s HTA bodies and payers. Factor into this the rapidly escalating cost of cancer drugs, the down pressure of global markets and pricing and the pricing inflexibility in the UK, and you can see why patients have concerns about getting access to the treatments they need.

6 6 HEALTHAWARENESS.CO.UK A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE INDEPENDENT MEDIAPLANET NEWS EXPERT OPINION Professor Andrew Biankin Director, The Wolfson Wohl Cancer Research Centre, University of Glasgow Moving forward Despite ongoing efforts, there has been almost no progress in the last 40 years for pancreatic cancer. It is clear that what we are doing is not working, and that we need to take a new approach. Unlike many cancers, which have a dominant druggable subtype, pancreatic cancer does not and has many low prevalence sub types. A better understanding of these subtypes is paramount, because it improves our ability to develop the right therapy for each patient. A key factor in this is close collaboration between research and clinical practice. It is absolutely vital that people suspected of having pancreatic cancer are fast tracked for tests. If a diagnosis is confirmed, the next step should be a biopsy to determine the disease s subtype. In this way, each patient could then be given the opportunity to participate in a clinical trial that is testing the right drug for the particular subtype of pancreatic cancer they have, rather than a one size fits all approach. It s a really simple concept. All the tricks that other cancers play in order to bypass treatment or become resistant to it are probably already present in pancreatic cancer, to one degree or another. This makes the disease the ultimate cancer, and has led over the years to some kind of resignation among the public, healthcare professionals, and governments. It s time to change the attitude towards pancreatic cancer from one of nihilism to one of action. That means enabling patients to make decisions, providing them and their doctors with attractive options for clinical trials, and integrating those clinical trials directly into the patients treatment. This is not just research. It s the best option for patients. healthawareness. co.uk A constant battle. A widening scope of research is improving survival rates for pancreatic cancer, but more can be done Better access to diagnostic tools and care is needed for pancreatic cancer By Lorena Tonarelli Difficult to diagnose and treat, pancreatic cancer has the lowest survival rate of all cancers and incredibly low research funding, says Ali Stunt, founder and CEO of Pancreatic Cancer Action. Pancreatic cancer is the fifth most common cause of cancer death in the UK, killing nearly 9,000 people annually. The average life expectancy is four to six months. Only 4 per cent of those diagnosed with the illness survive for five years. To put these figures into perspective, consider that the average five-year survival rate for breast cancer, for example, is 87 per cent. Not a silent killer Many people think that pancreatic cancer is a silent killer, but it s not, says Stunt. In fact, it can be a very symptomatic disease. Patients can have abdominal pain, unexplained weight loss, dark urine and yellow skin and eyes. In addition, because the pancreas is responsible for producing digestive enzymes, they may not be able to get nutrition from their food. Other potential symptoms include back pain, appetite loss, nausea and vomiting. Difficult to diagnose The problem is that the symptoms of pancreatic cancer are often mistaken for those of other disorders, such as irritable bowel syndrome, for example. So, the diagnosis is difficult to make. Yet, it is important. Stunt explains: The only treatment option for people with pancreatic cancer is surgery. So, it s vital that they get diagnosed in time for it. This increases their chances of survival tenfold. But often they are not referred to a specialist for further tests, or they may be sent for the wrong test, such as a colonoscopy instead of an internal examination of the pancreas, because cancer is not suspected. We know that some will visit their GP four times before they are referred to a specialist. Management challenges The management of pancreatic cancer is equally challenging. Because there is no cure for the illness, treatment is usually aimed at controlling symptoms. The management of pain can be particularly problematic, notes Stunt. Patients may also need enzyme supplements to help them get nourishment from their food and avoid losing weight. These supplements contain pancreatin a mixture of chemical compounds that help the digestion of sugars, proteins and fats. Uphill struggle Stunt continues: Unfortunately, public awareness of the condition is dire. A survey by Pancreatic Cancer Action showed that 87 per cent of the UK population does not know where the pancreas is in the body, and that 57 per cent of those with the illness have never heard of it before their diagnosis. We are clearly facing an uphill struggle. Taking action What can we do about it? We can increase knowledge of the disease Pancreatic cancer receives only 1 per cent of the total budget for research Ali Stunt CEO, Pancreatic Cancer Action PHOTO CREDIT: XRENDER among the public and healthcare professionals. To this aim, Pancreatic Cancer Action developed a learning tool in collaboration with the Royal College of GPs to help doctors understand the diagnosis of the illness in primary care. However, we also need to improve outcomes for people with the disease, for example by increasing the number of those involved in clinical trials, so that more treatments can be properly evaluated and brought to patients. Currently, only 7 per cent of affected people in the UK are in clinical trials, and there are only a few drugs in the pipeline for the advanced form of the disease, which 80 per cent of all patients have at diagnosis. We desperately need to get any sort of therapy assessed in studies, and to increase collaboration at an international level in order to expand access to clinical trials beyond those taking place in the UK, says Stunt. Indeed, research is the gateway to widening treatment options and consequently improving survival. Yet, pancreatic cancer receives only 1 per cent of the total budget for research, according to data from the National Cancer Research Institute (NCRI). Lastly, there should be faster referrals for diagnostic tests, including the ability for GPs to order a CT scan when pancreatic cancer is suspected, without the need for patients to see a specialist. Currently, only specialists have access to CT scans, concludes Stunt.

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